ABSTRACT
Increased efforts are required to prevent further losses to terrestrial biodiversity and the ecosystem services that it provides1,2. Ambitious targets have been proposed, such as reversing the declining trends in biodiversity3; however, just feeding the growing human population will make this a challenge4. Here we use an ensemble of land-use and biodiversity models to assess whether-and how-humanity can reverse the declines in terrestrial biodiversity caused by habitat conversion, which is a major threat to biodiversity5. We show that immediate efforts, consistent with the broader sustainability agenda but of unprecedented ambition and coordination, could enable the provision of food for the growing human population while reversing the global terrestrial biodiversity trends caused by habitat conversion. If we decide to increase the extent of land under conservation management, restore degraded land and generalize landscape-level conservation planning, biodiversity trends from habitat conversion could become positive by the mid-twenty-first century on average across models (confidence interval, 2042-2061), but this was not the case for all models. Food prices could increase and, on average across models, almost half (confidence interval, 34-50%) of the future biodiversity losses could not be avoided. However, additionally tackling the drivers of land-use change could avoid conflict with affordable food provision and reduces the environmental effects of the food-provision system. Through further sustainable intensification and trade, reduced food waste and more plant-based human diets, more than two thirds of future biodiversity losses are avoided and the biodiversity trends from habitat conversion are reversed by 2050 for almost all of the models. Although limiting further loss will remain challenging in several biodiversity-rich regions, and other threats-such as climate change-must be addressed to truly reverse the declines in biodiversity, our results show that ambitious conservation efforts and food system transformation are central to an effective post-2020 biodiversity strategy.
Subject(s)
Biodiversity , Conservation of Natural Resources/methods , Conservation of Natural Resources/trends , Environmental Policy/trends , Human Activities/trends , Diet , Diet, Vegetarian/trends , Food Supply , Humans , Sustainable Development/trendsABSTRACT
The effect of an increase in crop productivity (output per unit of inputs) on biodiversity is hitherto poorly understood. This is because increased productivity of a crop in particular regions leads to increased profit that can encourage expansion of its cultivated area causing land use change and ultimately biodiversity loss, a phenomenon also known as "Jevons paradox" or the "rebound effect". Modeling such consequences in an interconnected and globalized world considering such rebound effects is challenging. Here, we discuss the use of computable general equilibrium (CGE) and other economic models in combination with ecological models to project consequences of crop productivity improvements for biodiversity globally. While these economic models have the advantage of taking into account market-mediated responses, resource constraints, endogenous price responses, and dynamic bilateral patterns of trade, there remain a number of important research and data gaps in these models which must be addressed to improve their performance in assessment of the link between local crop productivity changes and global biodiversity. To this end, we call for breaking the silos and building interdisciplinary networks across the globe to facilitate data sharing and knowledge exchange in order to improve global-to-local-to-global analysis of land, biodiversity, and ecosystem sustainability.
Subject(s)
Agriculture , Ecosystem , Biodiversity , Models, Theoretical , Conservation of Natural ResourcesABSTRACT
Following the failure to fully achieve any of the 20 Aichi biodiversity targets, the future of biodiversity rests in the balance. The Convention on Biological Diversity's Kunming-Montreal Global Biodiversity Framework (GBF) presents the opportunity to preserve nature's contributions to people (NCPs) for current and future generations by conserving biodiversity and averting extinctions. There is a need to safeguard the tree of life-the unique and shared evolutionary history of life on Earth-to maintain the benefits it bestows into the future. Two indicators have been adopted within the GBF to monitor progress toward safeguarding the tree of life: the phylogenetic diversity (PD) indicator and the evolutionarily distinct and globally endangered (EDGE) index. We applied both to the world's mammals, birds, and cycads to show their utility at the global and national scale. The PD indicator can be used to monitor the overall conservation status of large parts of the evolutionary tree of life, a measure of biodiversity's capacity to maintain NCPs for future generations. The EDGE index is used to monitor the performance of efforts to conserve the most distinctive species. The risk to PD of birds, cycads, and mammals increased, and mammals exhibited the greatest relative increase in threatened PD over time. These trends appeared robust to the choice of extinction risk weighting. EDGE species had predominantly worsening extinction risk. A greater proportion of EDGE mammals (12%) had increased extinction risk compared with threatened mammals in general (7%). By strengthening commitments to safeguarding the tree of life, biodiversity loss can be reduced and thus nature's capacity to provide benefits to humanity now and in the future can be preserved.
Indicadores para monitorear el estado del árbol de la vida Resumen El futuro de la biodiversidad peligra tras no haberse logrado ninguno de los 20 Objetivos de Aichi. El Marco Global de Biodiversidad (GBF) de Kunming-Montreal del Convenio sobre la Diversidad Biológica (CDB) representa la oportunidad de preservar las contribuciones de la naturaleza a las personas (PNC) para las generaciones actuales y futuras mediante la conservación de la biodiversidad y la prevención de las extinciones. Es necesario salvaguardar el árbol de la vida -la historia evolutiva única y compartida de la vida en la Tierra- para mantener en el futuro los beneficios que aporta. En el GBF se han adoptado dos indicadores para supervisar los avances hacia el cuidado del árbol de la vida: el indicador de diversidad filogenética y el índice de especies evolutivamente distintas y globalmente amenazadas (EDGE). Aplicamos ambos a los mamíferos, las aves y las cícadas del mundo para demostrar su utilidad a escala mundial y nacional. El indicador de diversidad filogenética puede utilizarse para supervisar el estado de conservación general de grandes partes del árbol evolutivo de la vida, una medida de la capacidad de la biodiversidad para mantener los PNC para las generaciones futuras. El índice EDGE se utiliza para supervisar el rendimiento de los esfuerzos por conservar las especies más distintivas. El riesgo para la diversidad filogenética de aves, cícadas y mamíferos aumentó, y los mamíferos mostraron el mayor aumento relativo de la diversidad filogenética amenazada a lo largo del tiempo. Estas tendencias parecieron sólidas a la hora de elegir la valoración del riesgo de extinción. Las especies EDGE tuvieron un riesgo de extinción predominante cada vez peor. Una mayor proporción de mamíferos EDGE (12%) presentó un riesgo de extinción creciente en comparación con los mamíferos amenazados en general (7%). Si se refuerza el compromiso de salvaguardar el árbol de la vida, se puede reducir la pérdida de biodiversidad y preservar así la capacidad de la naturaleza para proporcionar beneficios a la humanidad ahora y en el futuro.
Subject(s)
Conservation of Natural Resources , Endangered Species , Humans , Animals , Phylogeny , Biodiversity , MammalsABSTRACT
Vegetated buffers and filter strips are a widely used Best Management Practice (BMP) for enhancing streamside ecosystem quality and water quality improvement through nonpoint source pollutant removal. Most existing studies are either site-specific, rely on limited data points, or evaluate buffer width and slope as the only design variables for predicting sediment reduction, not considering other parameters such as soil texture, vegetation types, and runoff loads that can significantly influence the buffer efficiency. In this paper, we carry out a meta-analysis of published studies and fit regression models to explore the sediment removal capacity of riparian buffers. We compiled 905 data points from over 90 studies (including data from an online BMP database) documenting sediment trapping by vegetated buffers and recorded data regarding buffer characteristics such as buffer width, slope, area, vegetation type, sediment loading, water flow rates, and sediment removal efficiency. We found that an exponential regression model describing the relationship between sediment removal efficiency by the buffer and water inflow/outflow volume ratio explained 44% of the variance. Adding the square root of roughness increased the R 2 to 0.50. The model performance was compared with other sediment reduction regression models reported in the literature. The results point towards the importance of considering flow parameters in vegetative buffer design. The improved empirical relationships derived here can be used at local scales to understand sediment trapping potential by vegetated buffers for water quality mitigation purposes and can be built into extant hydrologic models for improved watershed-scale assessments.
Subject(s)
Animals, Wild , Zoonoses , Animals , Humans , Zoonoses/epidemiology , Zoonoses/prevention & controlABSTRACT
Current diets of most nations either do not meet the nutrition recommendations or transgress environmental planetary boundaries or both. Transitioning toward sustainable diets that are nutritionally adequate and low in environmental impact is key in achieving the United Nations' Sustainable Development Goals. However, designing region-specific sustainable diets that are culturally acceptable is a formidable challenge. Recent studies have suggested that optimization algorithms offer a potential solution to the above challenge, but the evidence is mostly based on case studies from high-income nations using widely varying constraints and algorithms. Here, we employ nonlinear optimization modeling with a consistent study design to identify diets for 152 countries that meet four cultural acceptability constraints, five food-related per capita environmental planetary boundaries (carbon emissions, water, land, nitrogen, and phosphorus use), and the daily recommended levels for 29 nutrients. The results show that a considerable departure from current dietary behavior is required for all countries. The required changes in intake amounts of 221 food items are highly country-specific but in general point toward a need to reduce the intake of meat, dairy, rice, and sugar and an increase in fruits, vegetables, pulses, nuts, and other grains. The constraints for fiber, vitamin B12, vitamin E, and saturated fats and the planetary boundaries for carbon emissions and nitrogen application were the most difficult to meet, suggesting the need to pay special attention to them. The analysis demonstrates that nonlinear optimization is a powerful tool to design diets achieving multiple objectives.
Subject(s)
Diet , Nutritional Status , Algorithms , Meat , VegetablesABSTRACT
The extinction of species at the present leads to the loss of 'phylogenetic diversity' (PD) from the evolutionary tree in which these species lie. Prior to extinction, the total PD present can be divided up among the species in various ways using measures of evolutionary isolation (such as 'fair proportion' and 'equal splits'). However, the loss of PD when certain combinations of species become extinct can be either larger or smaller than the cumulative loss of the isolation values associated with the extinct species. In this paper, we show that for trees generated under neutral evolutionary models, the loss of PD under a null model of random extinction at the present can be predicted from the loss of the cumulative isolation values, by applying a non-linear transformation that is independent of the tree. Moreover, the error in the prediction provably converges to zero as the size of the tree grows, with simulations showing good agreement even for moderate sized trees (n=64).
Subject(s)
Biodiversity , Extinction, Biological , Phylogeny , Models, BiologicalABSTRACT
The UNEP-SETAC life cycle initiative recently recommended use of the countryside species-area relationship (SAR) model to calculate the characterization factors (CFs; potential species loss per m2) for projecting the biodiversity impact of land use associated with a products' life cycle. However, CFs based on this approach are to date available for only six broad land use types without differentiating between their management intensities and have large uncertainties that limit their practical applicability. Here we derive updated CFs for projecting potential species losses of five taxa resulting from five broad land use types (managed forests, plantations, pasture, cropland, urban) under three intensity levels (minimal, light, and intense use) in each of the 804 terrestrial ecoregions. We utilize recent global land use intensity maps and International Union for Conservation of Nature (IUCN) habitat classification scheme to parametrize the SAR model. As a case study, we compare the biodiversity impacts of 1 m3 of wood produced under four different forest management regimes in India and demonstrate that the new land use intensity-specific CFs have smaller uncertainty intervals and are able to discern the impacts of intensively managed land uses from the low intensity regimes, which has not been possible through previous CFs.
Subject(s)
Biodiversity , Forests , Conservation of Natural Resources , Ecosystem , India , WoodABSTRACT
Anthropogenic land use to produce commodities for human consumption is the major driver of global biodiversity loss. Synergistic collaboration between producers and consumers in needed to halt this trend. In this study, we calculate species loss on 5 min × 5 min grid level and per country due to global agriculture, pasture and forestry by combining high-resolution land use data with countryside species area relationship for mammals, birds, amphibians, and reptiles. Results show that pasture was the primary driver of biodiversity loss in Madagascar, China and Brazil, while forest land use contributed the most to species loss in DR Congo and Indonesia. Combined with the yield data, we quantified the biodiversity impacts of 1 m(3) of roundwood produced in 139 countries, concluding that tropical countries with low timber yield and a large presence of vulnerable species suffer the highest impact. We also calculated impacts per kg for 160 crops grown in different countries and linked it with FAO food trade data to assess the biodiversity impacts embodied in Swiss food imports. We found that more than 95% of Swiss consumption impacts rest abroad with cocoa, coffee and palm oil imports being responsible for majority of damage.
Subject(s)
Agriculture/methods , Biodiversity , Forests , Spatial Analysis , Animals , Birds , Crops, Agricultural/growth & development , Food , Geography , Humans , Mammals/physiology , SwitzerlandSubject(s)
Conservation of Natural Resources , Diet, Healthy , Food Supply , Agriculture/trends , Earth, Planet , Global Health , HumansABSTRACT
Habitat degradation and subsequent biodiversity damage often take place far from the place of consumption because of globalization and the increasing level of international trade. Informing consumers and policy makers about the biodiversity impacts "hidden" in the life cycle of imported products is an important step toward achieving sustainable consumption patterns. Spatially explicit methods are needed in life cycle assessment to accurately quantify biodiversity impacts of products and processes. We use the Countryside species-area relationship (SAR) to quantify regional species loss due to land occupation and transformation for five taxa and six land use types in 804 terrestrial ecoregions. Further, we calculate vulnerability scores for each ecoregion based on the fraction of each species' geographic range (endemic richness) hosted by the ecoregion and the IUCN assigned threat level of each species. Vulnerability scores are multiplied with SAR-predicted regional species loss to estimate potential global extinctions per unit of land use. As a case study, we assess the land use biodiversity impacts of 1 kg of bioethanol produced using six different feed stocks in different parts of the world. Results show that the regions with highest biodiversity impacts differed markedly when the vulnerability of species was included.
Subject(s)
Biodiversity , Models, Theoretical , Animals , Crops, Agricultural/growth & development , Geography , Mammals , Species Specificity , UncertaintyABSTRACT
Addressing biodiversity impacts in life cycle assessment (LCA) has recently been significantly improved. Advances include the consideration of several taxa, consideration of vulnerability of species and ecosystems, global coverage and spatial differentiation. To allow a comparison of biodiversity impacts of different stressors (e.g., land and water use), consistent approaches for assessing and aggregating biodiversity impacts across taxa are needed. We propose four different options for aggregating impacts across taxa and stressors: equal weight for species, equal weight for taxa and two options with special consideration of species' vulnerability. We apply the aggregation options to a case study of coffee, tea and sugarcane production in Kenya for the production of 1 kg of crop. The ranking between stressors (land vs water use) within each crop and also of the overall impact between crops (coffee>sugarcane>tea) remained the same when applying the different aggregation options. Inclusion of the vulnerability of species had significant influence on the magnitude of results, and potentially also on the spatial distribution of impacts, and should be considered.
Subject(s)
Agriculture/methods , Biodiversity , Camellia sinensis , Coffea , Crops, Agricultural , Kenya , Saccharum , WaterABSTRACT
Volatile organic compounds (VOCs) that negatively affect human health are emitted from wood products used indoors. However, the existing life cycle inventories of these products only document the emissions occurring during production and disposal phases. Consequently, the life cycle assessment (LCA) of indoor wooden products conducted using these inventories neglect the use-phase impacts from exposure to offgassed VOCs and therefore underestimate the product's total environmental impact. This study demonstrates a methodology to calculate the use phase inventory and the corresponding human health impacts resulting from indoor use of any VOC emitting product. For the five most commonly used types of boards used in indoor wood products, the mass of each VOC emitted into the indoor compartment over their service life was calculated by statistically analyzing data from 50 published chamber testing studies. Uncertainty was assessed using Monte Carlo simulations. The calculated inventory data were used in a case study to calculate and compare the health impacts of five different wooden floorings made of above materials. The results show that the use-phase human-toxicity impacts are an order of magnitude higher than those occurring during the rest of the flooring's life cycle. The factors influencing the offgassing of VOCs from wood products and measures to reduce exposure are discussed.
Subject(s)
Air Pollution, Indoor/analysis , Floors and Floorcoverings , Risk Assessment/methods , Volatile Organic Compounds/analysis , Air Pollution, Indoor/adverse effects , Environment , Environmental Exposure/adverse effects , Environmental Exposure/analysis , Formaldehyde/toxicity , Humans , Volatile Organic Compounds/toxicity , WoodABSTRACT
Various properties of gold nanoparticles (GNPs) are found to play crucial roles in their biological activity. Among them, the morphology and surface chemistry are extremely important. This is because of differences in surface energies of various crystal facets arising from a large fraction of edges, corners and vertices. In the present work, we provide a comparative study on the adsorption and binding affinities of bovine serum albumin (BSA) onto triangular gold nanoplates (TGNP) and gold nanorods (GNR). The results were compared with similar size of both CTAB and citrate stabilized spherical GNPs. Our data suggested stronger binding of BSA on citrate stabilized spherical GNPs whereas TGNP shows the weakest binding among all the GNPs. A blue shift of approximately 20 nm in tryptophan fluorescence was observed for all CTAB stabilized GNPs, indicating the local dielectric changes surrounding the tryptophan residue. Loss of the secondary structure was also observed for all CTAB stabilized GNPs. No spectral shift was observed for citrate stabilized spherical GNPs though maximum quenching of fluorescence and minimum structural loss was observed. With the help of molecular simulation recently developed by our group, a binding model is proposed to explain all the above experimental results.
Subject(s)
Gold/chemistry , Metal Nanoparticles/chemistry , Metal Nanoparticles/ultrastructure , Models, Chemical , Models, Molecular , Serum Albumin, Bovine/chemistry , Serum Albumin, Bovine/ultrastructure , Adsorption , Binding Sites , Computer Simulation , Materials Testing , Particle Size , Surface PropertiesABSTRACT
Among the various surface properties, nanoparticle curvature has a direct effect on the inner root of protein nanoparticle interaction. However, the orientation of adsorbed proteins onto the nanoparticle surface and its binding mechanism still remains elusive because of the lack of in-depth knowledge at the molecular level. Here, we demonstrate detail molecular insights of the orientational switching of several serum proteins as a function of nanoparticle curvature using theoretical simulation along with some experimental results. With the variation of binding stability, four distinctly different classes of orientation were observed for human serum albumin, whereas only two unique classes of conformations were observed for ubiquitin, insulin, and haemoglobin. As a general observation, our data suggested that orientations were exclusively dependent on the specific protein structure and the geometrical fitting onto the nanoparticle surface.
Subject(s)
Gold/chemistry , Metal Nanoparticles/chemistry , Serum Albumin/chemistry , Humans , Hydrodynamics , Molecular Docking Simulation , Protein ConformationABSTRACT
Background Rheumatic heart disease (RHD) is a chronic cardiovascular condition stemming from an infectious origin, posing a substantial health burden, particularly in economically disadvantaged regions. It starts with acute rheumatic fever (ARF), a complication following group A Streptococcus infection, leading to heart valve damage and, over time, structural heart abnormalities. RHD contributes to premature deaths, especially in low-middle-income countries. Although the incidence and prevalence have generally reduced globally due to antibiotics and improved healthcare, it remains a significant public health concern in Brazil, echoing its prevalence in many developing nations around the world. RHD stands as a poignant testament to the intersection of socio-economic disparities and healthcare challenges within Brazil's diverse population. In Brazil, despite advancements in healthcare, RHD continues to impact communities, highlighting the urgent need for enhanced prevention strategies, access to quality healthcare services, and heightened awareness to combat this preventable, yet persistent, cardiac condition. Understanding the epidemiological landscape and socio-cultural factors influencing RHD in Brazil is crucial for developing targeted interventions aimed at mitigating its burden on individuals, families, and the healthcare system at large. Thus, our study focuses on analyzing age-related mortality rates linked to ARF and chronic RHD (ARHD) in Brazil from 2000 to 2021, particularly examining gender disparities. Materials and methods This retrospective cohort study employed a descriptive time-series approach, utilizing comprehensive nationwide data from Brazil spanning from 2000 to 2021 to assess trends in diverse age groups, among both sexes, enabling a detailed analysis of temporal patterns. Mortality data, extracted and categorized meticulously, were subjected to Joinpoint statistical analyses enabling comparative assessments, with average annual percent change (AAPC) and annual percent change (APC) serving as key metrics to quantify and interpret trends over the analyzed period. Results The acute RHD (ARHD)-related mortality declined over the analyzed years supported by AAPC, with higher mortality reduction in females. The age-adjusted mortality rate for "males and females" decreased from 78 to 67 deaths/100,000 from 2000 to 2021. Female mortality dropped from 85 to 69/100,000, and male mortality decreased from 73 to 63/100,000 over the same period. For ARHD, male age groups (20-29, 60-69, 70-79, 80+) showed declining mortality, while the 30-59 age group exhibited an upward. Females AAMR for chronic RHD (CRHD) decreased across all age groups, with significant reductions in the 80 years and above age group from 2000-2002 (APC: -11.94*) and steadily from 2002 onwards (APC: -1.33). Conclusions Our study revealed an overall decline in mortality rates for both acute and CRHD across both sexes. Females consistently exhibited higher mortality rates and a more pronounced reduction compared to males in both acute and CRHD. In ARHD, males experience the highest mortality in the 50-59 age group, while females have a peak in the 40-49 age group. The 60-69 age group had the highest mortality in CRHD for both sexes. Conversely, the 20-29 age group displayed the lowest mortality in CRHD, and the 80-89 age group had the lowest mortality in ARHD.
ABSTRACT
This case report outlines the successful management of post-traumatic arthritis (PTA) in the left hip of a 60-year-old male with a history of a subtrochanteric femur fracture treated with Jewett Nail Plate osteosynthesis four decades ago. Despite seeking relief from various healthcare facilities and attempting alternative therapies, the patient experienced persistent pain and limited mobility. The decision was made to perform elective implant removal followed by total hip arthroplasty (THA). The surgical intervention involved a modified posterior approach, addressing specific challenges such as acetabular superior wall deficit and femoral sclerosis. A comprehensive management approach, considering the patient's complex medical history, including prolonged tobacco use and alcohol consumption, contributed to the successful outcome. Postoperative care included a multimodal drug cocktail for pain management and a well-coordinated physiotherapy program. Postoperative imaging confirmed the procedure's success, and the patient exhibited significant improvement in pain relief and functional outcomes. This case underscores the importance of a tailored and comprehensive approach in managing PTA, showcasing the effectiveness of elective implant removal followed by THA in addressing PTA of the hip.
ABSTRACT
Background The coronavirus disease 2019 (COVID-19) pandemic provoked disruptions in healthcare delivery. Following the recommendations of major surgical societies and surgical departments globally, most surgeries were widely canceled or postponed, causing significant disruptions to healthcare delivery worldwide, including in Brazil. Brazil's public healthcare system - Sistema Único de Saúde (SUS) was particularly affected, with a substantial decline in elective procedures, especially during the pandemic's early stages. The impact of the pandemic on surgical services in Brazil has not been adequately studied since most studies only cover the early phases of the pandemic. Thus, this study aims to analyze the case fatality rates and costs, associated with the different surgical procedure subgroups performed during the pre-pandemic, pandemic, recovery, and post-pandemic periods in all five regions of Brazil. Methods A retrospective cross-sectional design was used to examine surgical cases from 2019 to 2022. Data was divided into four time periods, named as the pre-pandemic (March-December 2019), pandemic (March-December 2020), recovery (March-December 2021), and post-pandemic (March-December 2022), and was analyzed for the cost of surgical procedures in the aforementioned four periods. In addition, the case fatality rates and rate ratios in the four periods stratified according to region were calculated. Results The cost of surgical procedures decreased during the pandemic and recovery period compared with pre-pandemic for all procedures except thoracic surgery where it was higher in the recovery period than pre-pandemic. No statistically significant change in cost was observed in surgeries of the central and peripheral nervous system, circulatory system, obstetric, and oncology. Case fatality rates increased among all five regions of Brazil in pandemic and recovery periods compared to pre-pandemic and post-pandemic periods. Case fatality rates increased during the pandemic and/or recovery as compared to pre-pandemic in all procedures except visual apparatus and obstetric surgeries were not affected by the pandemic in terms of case fatality rates. Conclusion The COVID-19 pandemic had a significant impact on surgical care costs and case fatality rates for surgery in Brazil. There was a decreasing trend in the costs of procedures during the pandemic, followed by a gradual recovery to baseline values, except for thoracic surgery. Case fatality rates rose initially and then declined, ultimately reaching baseline levels. The pandemic posed significant challenges to the healthcare system, affecting medical services, including surgical care.
ABSTRACT
This meta-analysis aims to systematically review and analyze available studies on the association between myocarditis and dengue viral fever. A comprehensive literature search was carried out using several databases. Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size using random effect models. Besides, random effects models were used to calculate the overall pooled prevalence. Data from 26 articles (6622 dengue patients) showed that pooled estimate of myocarditis in dengue fever was 12.4% (95% CI, 8.41-17.08). Higher prevalence was seen in reports from Asia (15.2%) compared to that from Latin America (3.6%). Besides, the pooled prevalence of severity and mortality was 34% (95% CI, 20.49-49.04) and 26.44% (95% CI, 18.07-35.78) respectively. Significantly higher prevalence rates of severe disease in the pediatric population (52.4%) and studies with a higher percentage of females (52.1%) were also observed. However, higher mortality rates were seen in the adult population (34.8%) compared with the pediatric age group. Further, myocarditis in dengue patients was associated with increased risk of severity (RRâ¯=â¯2.44, 95% CI 1.007-5.93, Pâ¯=â¯0.048) and mortality (RRâ¯=â¯19.41, 95% CI 7.19-52.38, P < 0.001) compared with dengue patients without myocarditis. No significant publication bias was evident in the meta-analysis. The findings highlight the clinical significance of early identification and management of myocarditis in patients with dengue fever.